The BRIGHT tool
1 Department of General Practice and Primary Health Care, School of Population Health, University of Auckland, Private Bag 92019, New Zealand
2 School of Nursing, Auckland University of Technology (AUT), Auckland, New Zealand
3 Home and Older Adult Services, Waitemata District Health Board, Auckland, New Zealand
4 Epidemiology and Biostatistics, School of Population Health, University of Auckland, New Zealand
Address correspondence to: Ngaire Kerse. Tel: 64 9 3737999x84467; Fax: 64 9 3737624. Email: n.kerse{at}auckland.ac.nz
Objective: the size of the burden of unmet needs of older people living in the community is unknown. We aim to validate a brief postal questionnaire, the Brief Risk Identification of Geriatric Health Tool (BRIGHT) questionnaire, to find cases of older people with disabilities (case-finding) living in the community.
Methods: community-dwelling patients over the age of 75 years were invited from two general practitioners in Auckland, New Zealand. Participants completed the 11-item BRIGHT questionnaire twice and were assessed at home using the Minimum Dataset for Home Care (MDS-HC) comprehensive geriatric assessment tool by a trained gerontology nurse. Retest reliability of the BRIGHT was assessed with a correlation coefficient, and receiver operator characteristic (ROC) curves were used to assess the utility of the tool against standard outputs from the MDS-HC reflecting level of disability; the instrumental activities of daily living clinical assessment protocol (IADL CAP), and the MAPle score for dependency.
Results: 101 participants completed both the BRIGHT questionnaires and the comprehensive MDS-HC assessment. Test-retest reliability was modest with a correlation of 0.77. A sensitivity of 0.86 and specificity of 0.86 were observed for a score of 3 or more on the questionnaire in relationship to the IADL CAP. A sensitivity of 0.65 and specificity of 0.84 were observed when BRIGHT questionnaire score of 3+ was related to the MAPLe score from the MDS-HC assessment.
Conclusions: the BRIGHT questionnaire has acceptable utility in identifying community-dwelling older people with disability, and excellent utility in ruling them out of needing further assessment. This tool may be useful as part of an intervention process to detect unmet needs and to improve systematic surveillance of primary care populations.
Keywords: case-finding, disability, postal questionnaire, utility, elderly
Received 4 October 2007; accepted in revised form 6 March 2008.